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Advisory Services Analyst – Medicaid Job in Milford Mill, MD – Mathematica

 
 

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Advisory Services Analyst – Medicaid

Mathematica Milford Mill, MD Full-Time

  • Position Description*:

Mathematica applies expertise at the intersection of data, methods, policy, and practice to improve well-being around the world. We collaborate closely with public- and private-sector partners to translate big questions into deep insights that improve programs, refine strategies, and enhance understanding using data science and analytics. Our work yields actionable information to guide decisions in wide-ranging policy areas, from health, education, early childhood, and family support to nutrition, employment, disability, and international development. Mathematica offers our employees competitive salaries, and a comprehensive benefits package, as well as the advantages of being 100 percent employee owned. As an employee stock owner, you will experience financial benefits of ESOP holdings that have increased in tandem with the companys growth and financial strength. You will also be part of an independent, employee-owned firm that is able to define and further our mission, enhance our quality and accountability, and steadily grow our financial strength. Learn more about our benefits here: [ Link removed ] – Click here to apply to Advisory Services Analyst – Medicaid

 

Mathematica is searching for analysts with experience in Medicaid policy and programs at either the state or federal level. In particular, we are looking for individuals who can support current and emerging work across any number of areas related to monitoring and improving Medicaid programs such as: Medicaid managed care programs, value-based purchasing and alternative payment models, long-term services and supports, measures of delivery and quality of services for beneficiaries, data analytics, and outcomes of innovative programs and policies. Additionally, Medicaid analysts will work on or support project management, change management, and business development. Medicaid analysts work on a variety of projects spanning policy and programmatic areas. These projects range from data analytics to program evaluation and implementation support. Candidates do not need to have experience in all of these areas but should have substantial experience in at least one of them.

Medicaid analysts will likely be connected to 2-3 projects at a time, with many projects requiring team leadership and direct-client contact. Across all projects, Medicaid analysts are expected to:

  • Lead or participate actively and thoughtfully in multidisciplinary teams to implement and monitor policy and programs, drawing on your past experience with Medicaid programs
  • Apply rigorous analytic thinking to the collection and interpretation of quantitative and/or qualitative data, including analysis of Medicaid administrative data, managed care data, and site visits or telephone interviews with state and federal officials, health plan representatives, and providers
  • Bring creative ideas to the development of proposals for new projects
  • Provide the direction and organization needed to help keep projects on time and on budget and facilitate communications across and between internal and external stakeholders
  • Contribute to the growth, expertise, and institutional knowledge of staff working in the Medicaid area

Specific project or new business development activities may include:

  • Conducting research projects on topics related to state and federal Medicaid policy
  • Providing technical assistance to federal and state Medicaid stakeholders
  • Assisting with quantitative analyses using Medicaid enrollment, claims/encounter, financial and program data to support program monitoring, improvement, or evaluation
  • Developing technical specifications, user manuals, and other documentation to support the implementation of reporting systems and analytic tools
  • Authoring client memos, technical assistance tools, issue briefs, chapters of analytic reports, and webinar presentations

 
 

  • Position Requirements*:

Qualifications:

  • Masters degree or equivalent in data analytics, public policy, economics, statistics, public health, behavioral or social sciences, or a related field, and at least 3 years of experience working in health policy or health research, with a substantial portion of that time focused on some aspect of the Medicaid program at the state or federal level; or a bachelors degree and at least 7 years of state or federal Medicaid experience.
  • Strong foundation in quantitative and/or qualitative methods and a broad understanding of Medicaid program and policy issues
  • Excellent written and oral communication skills, including an ability to write clear and concise policy and/or technical memos and documents for diverse stakeholder audiences including program administrators and policymakers
  • Demonstrated ability to lead tasks or deliverables and coordinate the work of multidisciplinary teams
  • Strong organizational skills and high level of attention to detail; flexibility to manage multiple priorities, sometimes simultaneously, under deadlines

To apply, please submit a cover letter, resume, transcripts (unofficial are acceptable), and contact information for three references. Please also provide a writing sample that demonstrates policy analysis or program operation and monitoring skills, and reflects independent analysis and writing, such as a white paper or decision memo. You will also be asked to provide your desired salary range during the application process.

Various federal agencies with whom we contract require that staff successfully undergo a background investigation or security clearance as a condition of working on a project. If you are assigned to such a project, you will be required to obtain the requisite security clearance.

Available Locations: Princeton, NJ; Washington, DC; Cambridge, MA; Woodlawn, MD; Ann Arbor, MI; Oakland, CA; Chicago, IL; Remote

This position offers an anticipated annual base salary range of $70,000 – $95,000. This position may be eligible for a discretionary bonus based on individual and company performance.

In accordance with Executive Order 14042 and its implementing guidelines, all Mathematica employees must provide documentation that they have been fully vaccinated or obtain an accommodation through Human Resources by providing documentation from a licensed health care provider that they are unable to be vaccinated against COVID-19 because of a disability (which would include medical conditions) or provide an attestation that they are entitled to an accommodation because of a sincerely held religious belief, practice, or observance.

We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.

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Clipped from: https://www.careerbuilder.com/job/J3Q8D0777HQL58P7GYT?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

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Coord, Medicaid Entitlement at Molina Healthcare in Long Bch, California

 
 

 
 

Location: Long Bch / California

 
 

Employment type: Full-Time

Job Description

Job Summary

Provide screening of candidates toward identification of qualified, eligible prospects related to both long-term care needs and Medicaid coverage for enrollment. Assist our current members with renewing Medicaid coverage and ensure that all program participants are enrolled in and maintain all applicable benefits and entitlements.

Knowledge/Skills/Abilities

  • Outreach prospects who may qualify for enrollment
  • Conducts pre-screening for prospect Medicaid eligibility to assist prospect/member with Medicaid eligibility/coverage
  • Participates in the care team for continuous performance improvement: facilitates problem-solving for performance improvement; contributes to the team’s efforts to every member with respect, courtesy and fairness in a way that provides superior customer service
  • Educates and provides assistance to members and/or families with the completion and submission of Medicaid re-certification applications for potential and active members as needed via telephone and home visits.
  • Assists members with Medicaid re-certification package.
  • Educates, verifies, and gathers budget information and documents for members who have surplus or pooled trust.
  • Conduct home visits as needed to assist in completion of documents.
  • Submit documentation to state agency within specified time-frame to assure Medicaid coverage for participant.
  • Tracks the Medicaid eligibility status via state agency’s system and Medicaid hotline for all prospect and active members. Assists internal teams in verifying Medicaid eligibility through state agency enrollment system.
  • Monitors Medicaid re-certification time frames for each active member and maintain records on coverage status and recertification.
  • Documents all member contact and documentation regarding recertification in appropriate system.
  • Notifies member of upcoming loss of eligibility and assists in safe transition for disenrollment.
  • Maintains the highest level of integrity, courtesy, and respect while interacting with prospects and active members, employees, and business contacts.
  • Excellent communication, interpersonal, decision-making and customer service skills for frequent interaction with prospects and active members and internally with other business associates.
  • An independent thinker with a history of creating solutions to achieving goals with ability to work in a continuous quality improvement mode
  • Aptitude for using a fast-paced proactive vs. reactive approach maneuvering multiple tasks simultaneously including seamlessly changing priorities.
  • Significant electronic records management capabilities for moving around in a database and entering information.
  • Technical skills in e-faxing, electronic archiving or encryption.
  • Knowledge of current community health practices for the frail adult population and/or cognitively impaired seniors including the values offered with integrated care.

Job Qualifications

Required Education:

  • High School Diploma or equivalent

Preferred Education:

  • Associates Preferred

Required Experience:

  • 2+ years of experience with Medicaid eligibility, screening, application process, review, determining eligibility, recertification or processing.
  • Proficiency in navigating the internet and multi-tasking with multiple software / electronic documentation systems simultaneously.
  • Experience with a Corporate email system including calendar functionality, as well as Microsoft.
  • Role specific industry experience in Long-Term (LT) or Managed Long-Term Plan (MLTCP).
  • Experienced in one or more of the following additional areas: health insurance, home care environment, acute or sub-acute

PHYSICAL DEMANDS:

Working environment is generally favorable and lighting and temperature are adequate. Work is generally performed in an office environment in which there is only minimal exposure to unpleasant and/or hazardous working conditions. Must have the ability to sit for long periods. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function.

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.


Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

 
 

Clipped from: https://molina-healthcare.talentify.io/job/coord-medicaid-entitlement-long-bch-california-molina-healthcare-2015459?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

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Project Manager – Louisiana Medicaid Market Project Manager 2 – Metairie | Humana Careers

 
 

 
 

About this job

Description

The Project Manager 2 manages all aspects of a project, from start to finish, so that it is completed on time, as requested, and within budget. The Project Manager 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

Responsibilities

  • Leads in the design, communication, and implementation of the operational plan for completing work initiatives; monitors progress and performance against the project plan; takes action to resolve operational risks and minimize implementation delays.
  • Identifies, develops, and gathers the resources to complete the project.
  • Prepares designs and work specifications; develops project schedules, and selecting materials, equipment, project

Read more about this job

Apply now

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The best part of this company is the commitment to associates, which naturally leads to commitment to members.

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Medical Director, Mid-South

If you are an individual with a disability and require a reasonable accommodation to complete any part of the application process, or are limited in the ability or unable to access or use this online application process and need an alternative method for applying, you may contact yourcareer@humana.com for assistance.

Humana Health and Safety Policy
Humana and its subsidiaries will require full vaccination for associates and select contractors who conduct work outside of their home on behalf of Humana. This applies to those who work within our facilities; interact directly with members and patients; attend in-person meetings or trainings; and/or represent Humana at events or volunteer activities. Medical and religious exemptions will be available, and this policy will not supersede state or local laws. Learn more

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Humana will never ask, nor require a candidate to provide money for work equipment and network access during the application process. If you become aware of any instances where you as a candidate are asked to provide information and do not believe it is a legitimate request from Humana or affiliate, please contact yourcareer@humana.com to validate the request.

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Health Insurance Specialist | Centers for Medicare & Medicaid Services

Summary This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Offices of Hearings and Inquiries(OHI). As a Health Insurance Specialist, GS-0107-13, you will expected to be thoroughly skilled in reviewing and deciding appeals involving all areas and issues of the exchange eligibility and enrollment process. Responsibilities Keep current with significant changes in program laws, regulations, policy, guidance, and precedents related to assigned areas of responsibilities. Fully research the law, regulations, policy, guidance and precedents related to the facts and the issues of the appeal. Maintain professional contact with other offices within CMS and agencies with responsibilities under the Affordable Care Act, and confer with legal Counsel with CMS and HHS, as appropriate, regarding cases and issues being considered. Request additional information and documentation as necessary to fully develop the facts and the issues involved in the appeal. Prepare written decisions supporting and communicating the appeal determination in accordance with established CMS protocols and procedures. Requirements Conditions of Employment Qualifications ALL QUALIFICATION REQUIREMENTS MUST BE MET WITHIN 30 DAYS OF THE CLOSING DATE OF THIS ANNOUNCEMENT. Your resume must include detailed information as it relates to the responsibilities and specialized experience for this position. Evidence of copying and pasting directly from the vacancy announcement without clearly documenting supplemental information to describe your experience will result in an ineligible rating. This will prevent you from receiving further consideration. In order to qualify for the GS-13, you must meet the following: You must demonstrate in your resume at least one year (52 weeks) of qualifying specialized experience equivalent to the GS-12 grade level in the Federal government, obtained in either the private or public sector, to include: 1) Conducting or supporting administrative appeals adjudication, which may include hearing scripts, case briefs, hearings and decision drafts; 2) Developing or researching and interpreting statutes, regulations and program policies and procedures; AND 3) Communicating with internal and external stakeholders regarding the appeals process and appeals case adjudication. Experience refers to paid and unpaid experience, including volunteer work done through National Service programs (e.g., Peace Corps, AmeriCorps) and other organizations (e.g., professional; philanthropic; religious; spiritual; community, student, social). Volunteer work helps build critical competencies, knowledge, and skills and can provide valuable training and experience that translates directly to paid employment. You will receive credit for all qualifying experience, including volunteer experience. Time-in-Grade: To be eligible, current or former Federal employees and current or former Federal employees applying under the VEOA eligibility who hold or have held a permanent General Schedule position in the previous year must have served at least 52 weeks (one year) at the next lower grade level from the position/grade level(s) to which they are applying. Click the following link to view the occupational questionnaire: https://apply.usastaffing.gov/ViewQuestionnaire/11634642 Education Additional Information Bargaining Unit Position: Yes-American Federation of Government Employees, Local 1923 Tour of Duty: Flexible Recruitment/Relocation Incentive: Not Authorized Financial Disclosure: Not Required To ensure compliance with an applicable preliminary nationwide injunction, which may be supplemented, modified, or vacated, depending on the course of ongoing litigation, the Federal Government will take no action to implement or enforce Executive Order 14043 Requiring Coronavirus Disease 2019 Vaccination for Federal Employees. Therefore, to the extent a federal job announcement includes the requirement to be fully vaccinated against COVID-19 pursuant to Executive Order 14043, that requirement does not currently apply. Positions with vaccination requirements under authority(ies) separate and distinct from Executive Order 14043 will be clearly identified. HHS may continue to require documentation of proof of vaccination to ensure compliance with those policies. Health and safety protocols remain in effect, in accordance with CDC guidance and the Safer Federal Workforce Task force. Consistent with current guidance, workplace safety protocols will no longer vary based on vaccination status or otherwise depend on the availability of vaccination information. Therefore, to the extent a job announcement states that HHS may request information regarding the vaccination status of selected applicants for the purposes of implementing workplace safety protocols, this statement does not currently apply. Workplace Flexibility at CMS: CMS offers flexible working arrangements and allows employees the opportunity to participate in telework combined with alternative work schedules at the manager’s discretion. This position may be authorized for telework. Telework eligibility will be discussed during the interview process. The Interagency Career Transition Assistance Plan (ICTAP) and Career Transition Assistance Plan (CTAP) provide eligible displaced federal employees with selection priority over other candidates for competitive service vacancies. To be qualified you must submit the required documentation and be rated well-qualified for this vacancy. Click here for a detailed description of the required supporting documents. A well-qualified applicant is one whose knowledge, skills and abilities clearly exceed the minimum qualification requirements of the position. Additional information about ICTAP and CTAP eligibility is on OPM’s Career Transition Resources website at www.opm.gov/rif/employeeguides/careertransition.asp.

 
 

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RN, Manager, Utilization Management Nursing (Louisiana Medicaid) Job in New Orleans, LA – Humana

 
 

 
 

Description

Humana Healthy Horizons in Louisiana is seeking a Manager, Utilization Management Nursing who will utilize clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Manager, Utilization Management Nursing applies a Person-Centered approach, works within specific guidelines and procedures; applies advanced technical knowledge and clinical criteria to solve moderately complex problems; receives assignments in the form of team and/or department goals and objectives and determines approach, resources, schedules and monitors success of appropriate team or department goals.

Responsibilities

Essential Functions and Responsibilities

  • Supervise utilization management personnel and oversee all utilization management functions, including inpatient admissions, concurrent review, prior authorization and referrals to care management.
  • Oversee, monitor, orient and train staff in the use of standard utilization management criteria including MCG, Interqual, and ASAM.
  • Lead development of utilization management policies and procedures to ensure compliance with state and federal requirements and incorporate industry best practices.
  • Collaborate with internal departments, providers, and community partners to support the delivery of high-quality utilization management services, including introducing innovative approaches to utilization management.
  • Monitor and maintain staffing levels to meet care and service quality objectives.
  • Conduct timely evaluations of direct reports and provide regular opportunities for professional development.
  • Influence and assist corporate leadership in strategic planning to improve effectiveness of utilization management programs.
  • Collect and analyze performance reports on utilization management functions to monitor adherence with benchmarks, identify opportunities for process improvement, and develop recommendations to leadership.
  • Conducts briefings and area meetings; maintains frequent contact with other managers across the department and the company.

Required Qualifications

  • Licensed Registered Nurse (RN) in the state of Louisiana with no disciplinary action.
  • Must reside in the state of Louisiana.
  • Previous experience in utilization management.
  • Two (2) or more years of clinical experience preferably in an acute care, skilled or rehabilitation clinical setting.
  • Two (2) years of leadership experience.
  • Knowledge of Interqual, ASAM and/or Milliman (MCG) criteria.
  • Comprehensive knowledge of Microsoft Office applications including Word, Excel, and Outlook.
  • Ability to work independently under general instructions and with a team.
  • Must have the ability to provide a high speed DSL or cable modem for a home office.
  • A minimum standard speed for optimal performance of 25×10 (25mpbs download x 10mpbs upload) is required.
  • Satellite and Wireless Internet service is NOT allowed for this role.
  • A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
  • Humana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of vaccination, including COVID-19 boosters. Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask at all times while in a Humana facility or while working in the field.

Preferred Qualifications.

  • BSN, Bachelor’s degree in health services, healthcare administration, or related field.
  • Experience working with Medicaid and/or health plan Utilization Management.
  • Possess subject matter expertise in review of inpatient admission and concurrent reviews requests.
  • Experience managing staff who review and process prior authorization, inpatient admission reviews and concurrent reviews.
  • Experience serving Medicaid, TANF, and/or CHIP populations.

Additional Information.

  • Workstyle: Remote with limited travel.
  • Travel: Up to 10% to Humana Healthy Horizons locations in Metairie or Baton Rouge, LA
  • Typical Work Days/Hours: Monday – Friday; 8:00am – 5:00pm CST with potential rotating on-call schedule.
  • Direct Reports : up to 12 Associates.

Interview Format

As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

Scheduled Weekly Hours

40

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our [ Link removed ] – Click here to apply to RN, Manager, Utilization Management Nursing (Louisiana Medicaid)

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Clipped from: https://www.careerbuilder.com/job/J3P62679GDG5SB730TF?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Posted on

MaineCare Reimbursement Specialist, Augusta, Maine

Department of Health and Human Services (DHHS)
Opening Date: September 2, 2022
Closing Date: September 16, 2022
Job Class Code: 0441
Grade: 20
Salary: $39,395.20 – $52,894.40/year
Position Number:

Agency information:


The Department of Health and Human Services (DHHS) provides supportive, preventive, protective, public health and intervention services that help families and individuals meet their needs. DHHS strives to provide these programs and services while respecting the rights and preferences of individuals and families. The Office of MaineCare Services (OMS) within DHHS administers the state’s Medicaid program, which provides health insurance coverage for low-income families, adults and children so they can access the important health care services they need to be healthy and be a part of the community through work, caring for family, going to school, and more. OMS works collaboratively within DHHS, with other Departments and the Office of the Governor, with MaineCare members, with providers, and with other health care purchasers on statewide healthcare improvement initiatives. OMS is committed to advancing health equity efforts to improve access to care and health outcomes for all low-income Mainers. OMS provides benefit coverage and supports the services that operate in alignment with Department goals, federal mandates and State policy. OMS also provides oversight necessary to ensure accountability and efficient and effective administration.


The Drug Rebate Program is part of the Pharmacy Unit, within OMS. Drug Rebate is a program that includes Centers for Medicare & Medicaid Services (CMS), State Medicaid agencies, and participating drug manufacturers that helps to offset the Federal and State cost of most outpatient prescription drugs dispensed to Medicaid patients.


Job duties:


This position administers the Drug Rebate Program for the State of Maine. Responsibilities include, but are not limited to, submitting drug rebate invoices to participating drug manufacturers. Allocating and reconciling payments from drug manufacturers. Researching and analyzing national drug code (NDC) reports, paid claim information, and drug pricing and packaging information whenever a drug manufacturer disputes invoiced amounts. Negotiating and resolving disputed units with drug manufacturers and pharmacies. You will evaluate and interpret State and Federal statute, rules, and laws to comply with required procedures. Attention to detail is a must, as is the ability to handle a large volume of work and to make decisions independently. Additional duties are described below.

  • Provide detailed reports of drug utilization as requested by manufacturers so they may review the data prior to paying a rebate.
  • Resolve disputes when the manufacturer disputes the invoiced total units. This may require contacting a pharmacy to verify a member’s prescription of what was dispensed.
  • Review outstanding balances to see if a manufacturer has credits on file or owes a balance.
  • Provide claim level detail (CLD) reports to support the invoiced amount.
  • Respond timely to questions from manufacturers.
  • Request invoice backup from the manufacturer so that a payment may be allocated correctly and reconciled.

This position reports to the Pharmacy Operations Manager. This is a full-time position located at 109 Capitol Street, Augusta, Maine. This opportunity allows partial telework with management approval.

Minimum Qualifications:


A Bachelor’s Degree in Accounting, Business Administration or related field and one (1) year of experience in healthcare insurance or a related insurance field. Directly related work experience may be substituted for education requirements on a year-for-year basis.


Preferred experience includes:

  • Experience with and knowledge of the Medicaid program and/or other health and human services programs serving low-income populations
  • Lived experience with Medicaid and/or other health-related social needs common to individuals and families receiving Medicaid coverage

The background of well-qualified candidates will demonstrate the following competencies:

 

  1. As a Reimbursement Specialist you frequently communicate by phone and in writing with physicians, pharmacists, drug labelers/manufacturers, attorneys, and federal CMS (Centers for Medicare and Medicaid Services). To successfully perform these duties, you will need strong oral and written communication skills. Please tell us about those aspects of your background that demonstrate you have the oral and written communication skills to be successful as a Reimbursement Specialist.
  2. Reimbursement Specialists are independent and self-directed workers who operate with considerable autonomy in establishing their day-to-day work activities and priorities. Please provide us with examples from your experience that demonstrate you are a self-directed worker capable of successfully performing your duties with minimal supervision.
  3. Reimbursement Specialists negotiate with drug labelers/manufacturers and federal CMS representatives in order to collect money for disputed payment amounts on drug invoices. Maintain two-way communications with them and use problem-solving techniques in order to negotiate a dispute resolution. Tell us about those experiences that demonstrate you can successfully perform duties requiring considerable research and negotiation skills.
  4. Drug manufacturers often challenge the Department’s attempt to recover delinquent accounts. As a Reimbursement Specialist, you will analyze quarterly drug rebate invoices for approximately 780 participating drug manufacturers for 4 different rebate programs. You will record and reconcile payments using knowledge of proper accounting principles. Analyze balances after posting payment in order to identify disputes and reasons for disputes. Please tell your experiences that demonstrate effective accounting principles.
  5. Reimbursement Specialist must have pharmacy knowledge and an understanding of a preferred drug list. They should be able to review pharmacy claims and have an understanding of a pharmacy formulary and/or preferred drug list in order to respond to drug manufacturers. Please tell your experience that demonstrate proficient pharmacy experience.

Application Information:

Please submit all documents or files in a PDF or Word format.


For additional information about this position please contact Jan Wright at or by e-mail . To apply, upload a resume and cover letter addressing the five competency areas identified in the above section
.


To request a paper application, please contact .


Benefits


No matter where you work across Maine state government, you find employees who embody our state motto-“Dirigo” or “I lead”-as they provide essential services to Mainers every day. We believe in supporting our workforce’s health and wellbeing with a valuable total compensation package, including:

  • Work-Life Balance – Rest is essential. Take time for yourself using 13 paid holidays, 12 days of sick leave, and 3+ weeks of vacation leave annually. Vacation leave accrual increases with years of service, and overtime-exempt employees receive personal leave.
  • Health Insurance Coverage – The State of Maine pays 85%-100% of employee-only premiums ($10,150.80-$11,345.04 annual value), depending on salary. Use this chart to find the premium costs for you and your family, including the percentage of dependent coverage paid by the State.

 
 

  • Health Insurance Premium Credit – Participation decreases employee-only premiums by 5%. Visit the Office of Employee Health and Wellness for more information about program requirements.

 
 

  • Dental Insurance – The State of Maine pays 100% of employee-only dental premiums ($350.40 annual value).

 
 

  • Retirement Plan – The State of Maine contributes 13.16%of pay to the Maine Public Employees Retirement System (MainePERS), on behalf of the employee.
  • Gym Membership Reimbursement – Improve overall health with regular exercise and receive up to $40 per month to offset this expense.
  • Health and Dependent Care Flexible Spending Accounts – Set aside money pre-tax to help pay for out-of-pocket health care expenses and/or daycare expenses.
  • Public Service Student Loan Forgiveness – The State of Maine is a qualified employer for this federal program. For more information, visit the Federal Student Aid office.
  • Living Resources Program – Navigate challenging work and life situations with our employee assistance program.

 
 

  • Parental leave is one of the most important benefits for any working parent. All employees who are welcoming a child-including fathers and adoptive parents-receive four weeks of fully paid parental leave. Additional, unpaid leave may also be available, under the Family and Medical Leave Act.
  • Voluntary Deferred Compensation – Save additional pre-tax funds for retirement in a MaineSaves 457(b) account through payroll deductions.
  • Learn about additional wellness benefits for State employees from the Office of Employee Health and Wellness.

Maine State Government is an Equal Opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees….. click apply for full job details

 

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Posted on

Director I HCMS -Medicaid Jobs in SeattleWA at Elevance Health

 
 

Overview

Director I HCMS -Medicaid Jobs in SeattleWA at Elevance Health

Title: Director I HCMS -Medicaid

Company: Elevance Health

Location: SeattleWA

Job Family: Medical and Clinical
Type: Full time
Date Posted: Sep 14, 2022
Req #: JR22462

Description
Please note: This position supports the State of Washington Medicaid plan. To be considered for the position, you must reside in the state of Washington
Status: Full-time, Salaried with bonus potential, work from home
The Director I HCMS is responsible for managing the utilization and case management process for one or more member product populations of varying medical complexity ensuring the delivery of essential services that address the total healthcare needs of members.

Primary duties may include, but are not limited to:

Implements and manages health care management, utilization, cost, and quality objectives.
Ensures program compliance and identifies opportunities to improve the customer service and quality outcomes.
Oversees the development and execution of medical and case management policies, procedures, and guidelines; assists in developing clinical management guidelines.
Ensures medical management and case management activities are contracted, reviewed, and reported.
Supports quality initiatives and activities including clinical indicators reporting, focus studies, and HEDIS reporting.
Hires, trains, coaches, counsels, and evaluates performance of direct reports.

Requirements

BA/BS degree in a health care field
8 years clinical experience including prior management experience
Any combination of education and experience which would provide an

equivalent background.

Preferences

RN, LCSW, or LPC
National Committee for Quality Assurance (NCQA) accreditation and

HEDIS reporting experience

MS/MA degree in a health care field or MBA with Health Care concentration
Certified Case Manager

Please be advised that Elevance Health only accepts resumes from agencies that have a signed agreement with Elevance Health. Accordingly, Elevance Health is not obligated to pay referral fees to any agency that is not a party to an agreement with Elevance Health. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Be part of an Extraordinary Team
Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. Previously known as Anthem, Inc., we have evolved into a company focused on whole health and updated our name to better reflect the direction the company is heading.
We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide – and Elevance Health approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Elevance Health is able to reasonably accommodate. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World’s Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.ElevanceHealthinc.com. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ability@icareerhelp.com for assistance.

Clipped from: https://customercarejob.com/job/director-i-hcms-medicaid/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

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Manager, Utilization Management Behavioral Health – Louisiana Medicaid Job in Franklin, LA – Humana

Clipped from: https://www.careerbuilder.com/job/J3S19B69Z31NQFQ85HX?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Description

Humana Healthy Horizons in Louisiana is seeking a Manager, Utilization Management (Behavioral Health) who will utilize clinical skills to support the coordination, documentation, and communication of behavioral health services and/or benefit administration determinations. The Manager, Utilization Management Behavioral Health applies a Person-Centered approach, works within specific guidelines and procedures; applies advanced technical knowledge and clinical criteria to solve moderately complex problems; receives assignments in the form of team and/or department goals and objectives and determines approach, resources, schedules and monitors success of appropriate team or department S.M.A.R.T goals.

Responsibilities

Essential Functions and Responsibilities

  • Supervise utilization management personnel and oversee all utilization management functions, including inpatient admissions, concurrent review, prior authorization and referrals to care management.
  • Oversee, monitor, orient and train staff in the use of standard utilization management criteria including ASAM.
  • Lead development of utilization management policies and procedures to ensure compliance with state and federal requirements and incorporate industry best practices.
  • Collaborate with internal departments, providers, and community partners to support the delivery of high-quality utilization management services, including introducing innovative approaches to utilization management.
  • Monitor and maintain staffing levels to meet care and service quality objectives.
  • Conduct timely evaluations of direct reports and provide regular opportunities for professional development.
  • Influence and assist corporate leadership in strategic planning to improve effectiveness of behavioral health utilization management programs.
  • Collect and analyze performance reports on utilization management functions to monitor adherence with benchmarks, identify opportunities for process improvement, and develop recommendations to leadership.
  • Conducts briefings and area meetings; maintains frequent contact with other managers across the department and the company.

Required Qualifications

  • Must reside in the state of Louisiana.
  • Licensed Mental Health Practitioner (LMHP) who is licensed to practice independently in Louisiana and is in compliance with the requirements of one of the following regulated areas: Medical Psychologists, Licensed Psychologists, Licensed Clinical Social Workers (LCSWs), Licensed Professional Counselors (LPCs), Licensed Marriage and Family Therapists (LMFTs), Licensed Addiction Counselors (LACs) or Advanced Practice Registered Nurses (APRN) with specialization in adult psychiatric and mental health.
  • Two (2) or more years of clinical experience working with the behavioral health populations preferably in an acute care, skilled or rehabilitation clinical setting.
  • Previous experience in utilization management.
  • Two (2) years of leadership experience.
  • Knowledge of ASAM, Interqual and/or Milliman (MCG) criteria.
  • Comprehensive knowledge of Microsoft Office applications including Word, Excel, and Outlook.
  • Ability to work independently under general instructions and with a team.
  • Must have the ability to provide a high speed DSL or cable modem for a home office.
  • A minimum standard speed for optimal performance of 25×10 (25mpbs download x 10mpbs upload) is required.
  • Satellite and Wireless Internet service is NOT allowed for this role.
  • A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
  • This role is part of Humana’s Driver safety program and therefore requires an individual to have a valid state driver’s license and proof of personal vehicle liability insurance with at least 100,000/300,000/100,000 limits.
  • Humana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of vaccination, including COVID-19 boosters. Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask at all times while in a Humana facility or while working in the field.

Preferred Qualifications

  • Certified Case Manager (CCM) or willingness to obtain within 2 years of employment.
  • Experience serving Medicaid, TANF, and/or CHIP populations.

Additional Information

  • Workstyle: Remote.
  • Travel: 25% in-state travel.
  • Direct Reports: up to 12 Associates.
  • Section 1121 of the Louisiana Code of Governmental Ethics states that current or former agency heads or elected officials, board or commission members or public employees of the Louisiana Health Department (LDH) who work directly with LDH’s Medicaid Division cannot be considered for this opportunity. A separation of two (2) or more years from LDH is required for consideration. For more information please visit: Louisiana Board of Ethics (la.gov) ([ Link removed ] – Click here to apply to Manager, Utilization Management Behavioral Health – Louisiana Medicaid Format

As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

Scheduled Weekly Hours

40

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our [ Link removed ] – Click here to apply to Manager, Utilization Management Behavioral Health – Louisiana Medicaid

Recommended Skills

  • Administration
  • Behavioral Medicine
  • Benchmarking
  • Business Process Improvement
  • Case Management
  • Certified Case Manager
Posted on

Middle Alabama Area Agency on Aging – Case Manager

Clipped from: https://www.internships.com/posting/sam_LjlV4t1o7LACs7Ri5fd_2Aee3XHIhpXjIpkktC_0TrjAKYgr-HRIyg?context=merch&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Job Title: Case Manager for the Medicaid Waiver Service Program – Elderly and Disabled Waiver.

Job Location: Office in Alabaster – Agency serves Central Region (Blount, Chilton, Shelby, St Clair, and Walker counties)

Case load Areas- 1 case load in Blount County ; 1 case load in Walker County

Job Status: Full-time – Exempt

Summary: Case Managers serve Medicaid eligible clients who would otherwise require nursing home care and are at risk for nursing home placement. The Medicaid Waiver Service (MWS) program aims for clients to remain in their own home and delay/avoid institutionalization by locating, coordinating, and monitoring services. *NCQA accredited program.

Essential Duties and Responsibilities include the following:

  • Conduct Case Management services for clients on the MWS Elderly and Disable Waiver in the FamCare software system through monthly home visits.
  • Caseload is up to 40 elderly, disabled clients, and or disabled children using the medical social work model. Hiring for caseloads in Blount and Walker Counties.
  • Monitor the service delivery of the Care Plan and complete Assessments
  • Update data entry pertaining to medication, doctor appointments, durable medical equipment, and diagnosis data in real-time during home visits.
  • Counsel clients and assists to develop Smart Goals.

 
 

  • Coordinate Medicaid Re-determination, completes transitions tracking, documents medication, doctor changes/appointments, and tracks critical incidents.
  • Write effective documentation narratives

Education and Experience:

Bachelor’s Degree in social work, psychology, or related field. Experience in social work, especially the geriatric population is desired.

Relevant Knowledge:

Knowledge of social work principles and interviewing techniques.

Possess experience in MS Office, ability to learn new software, and general office procedures.

Ability to communicate clearly and effectively, both verbally and in writing.

Time management and organizational skills.

Additional Requirements:

· Possess a valid driver’s license.

· Must maintain automobile 100/300/100 liability insurance; TB Skin Testing upon hire.

Benefits: State of Alabama Retirement; State of Alabama Local Government Health Insurance (BCBS); and other benefits.

How to Apply: Email cover letter, resume, three references, and salary requirements.

Work Remotely

  • Possible with Supervisor’s clearance.

Job Types: Full-time, Part-time, Internship

Pay: From $17.16 per hour

Benefits:

  • Dental insurance
  • Flexible schedule
  • Health insurance
  • Retirement plan

Schedule:

  • 8 hour shift
  • Monday to Friday

COVID-19 considerations:
M4A follows CDC guidelines.

Education:

  • High school or equivalent (Preferred)

Work Location: One location

Posted on

Policy Analyst – Medicaid in Jackson, Mississippi

Clipped from: https://careers.mercy.net/job/887051/Policy-Analyst-Medicaid?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

 

MHAP – Jackson, MS Department MHA Mississippi Health Advocac Category Business Professional Location Jackson, Mississippi, United States Job Id: 887051 Mercy Posted on: 06/26/2022 Type: Full Time Days

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